Think tank urges action to stop ‘slow erosion’ of primary and community care

Primary and community care should be prioritised to ensure England’s health system is effective and sustainable, a think tank has said.

The King’s Fund also warned that the “answer to overcrowded hospitals is not more hospitals”.

A new report compiled by the organisation suggests that the lack of investment in primary and community healthcare is “one of the most significant and long-running” policy failures for more than three decades.

It is calling for a clear vision to bolster primary care services, more funding and more staff incentives to work in those settings, and reforms for the social care system.

Sarah Woolnough, chief executive of The King’s Fund, said: “The answer to overcrowded hospitals is not more hospitals.

“Despite this being well understood for many years, there is now a higher proportion of the NHS budget and staff going into hospital services. At the same time, there has been a slow erosion of capacity and confidence in primary and community care.”

According to The King’s Fund, there are 876,164 GP appointments on average every day, a rise of 34,219 since 2018/19.

However, it claims Department of Health and Social Care (DHSC) spending on primary care has fallen from 9.8% in 2015/16 to 8.1% in 2021/22, while the largest proportion – £83.2 billion – went to acute hospitals.

Ms Woolnough said: “Many people across the country will have personal experience of struggling to get a GP appointment, trying to contact other services, and when all avenues have been exhausted, reluctantly going to A&E. It feels like all roads lead to the hospital, but our hospitals are already full.

“To achieve an effective and sustainable health and care system, politicians and national leaders need to embark on a radical and wholesale refocusing of the health and care system towards primary and community services.

“Doing so will free up hospitals to treat the patients they are best placed to treat, thanks to many more people being diagnosed and cared for in the community.”

The King’s Fund said the report highlights “some actions and areas for policy development”, which include a suggestion that NHS England leaders should be encouraged to work in community settings to develop experience in a range of settings.

It also called for health providers to meaningfully engage with communities and said the DHSC should invest more in technology and estates for primary care, while the Government should allow integrated care boards (ICBs) and local authorities to plan for more than a single financial year.

Beccy Baird, a senior fellow at The King’s Fund and lead author of the report, said: “Like other countries, England needs to bend the curve on the predicted rise in demand for high-cost, reactive and hospital-based care.

“That means supporting people to take care of their health and wellbeing, intervening early and keeping people healthy at home for as long as possible, which can only be achieved by bolstering primary and community services.

“While these changes may not unlock the quick-fix savings many mistakenly expect, the alternative is to build more expensive hospitals to manage acute needs that could have been prevented or better managed in the community.”

NHS Providers, which represents NHS trusts in England, welcomed the report.

Its deputy chief executive Saffron Cordery said: “A clear vision for community and primary care services, backed by a plan for more funding and staffing, is vital.

“NHS services are looking after more people, many with more complex needs, in the community and consistently meet national targets to deliver urgent community response services. But there’s still more to do to ensure a sustainable future and achieve national ambitions to provide more care close to home.”

Ms Cordery said care provided in the community “is too often overlooked when headlines and political priorities focus on a narrow set of acute-focused targets”.

She added: “But prevention is better than cure and with the right funding and workforce then community, primary and social care can play an essential role.”

Professor Kamila Hawthorne, chairwoman of the Royal College of General Practitioners (RCGP), said: “GPs and our teams are the first port of call for most patients in the NHS, and as such our service alleviates pressures across the health service, so we greatly appreciate this recognition from The King’s Fund and its timely recommendations for more focus and funding for primary care.”

However, Prof Hawthorne warned family doctors are “stretched”, as demand for services rises with fewer qualified GPs.

“We now have an eye-watering 2,290 patients per doctor and are really feeling the strain,” she added.

“We share our patients’ frustration when they struggle to access the safe, timely and appropriate care they need – and key to addressing this is ensuring that general practice has the resource and people it needs.

“There is a widespread ambition to move more care into the community where it is more cost-effective, and it’s pivotal that funding follows patients, but that’s not what we are seeing. We need to turn this around.”

Rob Yeldham, director of strategy, policy and engagement at the Chartered Society of Physiotherapy (CSP), said the King’s Fund report “should be yet another wake-up call for Government and NHS leaders”.

He added: “The CSP has long advocated for and supported services such as rehabilitation moving into the community wherever appropriate as a means to ease the pressure on the NHS, but also provide the best outcomes for people.

“These efforts, however, will be in vain if politicians and system leaders do not take decisive, wholesale action as needed, and which this report identifies as so sorely lacking.”

The DHSC has been approached for comment.